Life History of an Older Adult

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When in our third year, we interviewed an elder at Broadway Pentecostal Lodge, I did not know what to expect. At the time, I had little experience interacting with elders, as even my own extended family members are relatively young. Much like my experience at Positive Living, my preconceptions were influenced by stereotypes and stories I had heard about long term care facilities. I expected to meet a grumpy old man or lady; someone with bed-ridden and quick to scold me for wasting time they could use for a nap. Thankfully, I was very wrong. I met a lovely lady well into her nineties but quick as whip, who welcomed me into her “home”, patted a seat on her bed beside her, and asked me, “So, what’s up?”

I learned how communication is so important as a dental hygienist, and as a human being.  You learn so much by having an open mind and spending time with someone. The experience was unforgettable, and really prepared me for my practicum I was participate in the following year at Broadway Lodge.

Immigrant Services Society

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Language barriers are a challenge in an oral health setting, especially if the individual also has low oral health literacy. For new immigrants to Canada, oral health information can be difficult to access and understand, especially for those who do not speak English fluently. As dental professionals, it is important to understand that this population may face challenges with oral health due to the ethnic or cultural differences as well as language barriers and health literacy issues.

In my second year community practice, my group was placed at the Immigrant Services Society at the English as a second language program for adults in Vancouver. Our goal was to help the individuals at ISS increase their oral health knowledge and vocabulary, as well as teach the students some oral self-care techniques. In addition, we wanted to help increase access to dental services for these newly immigrated individuals by providing information on booking appointments, where to find low-cost dental clinics, and how to communicate their needs with dental professionals.

New West Family Place

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The dental hygienist is an important member of the interprofesisonal health team for families. It is important to educate our clients for their own oral health, but also to educate them as a parent for the health of their children’s mouths. In my third year community rotation, my group visited New West Family Place (NWFP). NWFP provides support and resources for families with children up to age 5, and also serves as a drop-in daycare centre where the parents and children can play. NWFP also offers Parent Education Programs, where individuals are invited to speak on several topics, to help educate parents.

We were able to visit NWFP with the goal of raising oral health awareness for the entire family. At this site, we created lessons aimed at educating parents or caregivers of children under five years old. Our topics included nutrition and its impact on oral health, how to access dental services and when it is appropriate to do so for children, and lastly, oral self-care for all family members. We emphasized many issues that parents with young children may face, including baby bottle rot and early childhood caries, teething, as well as any questions that these parents had for dental professionals.

The experience was eye-opening, as I had not previously worked with a family as my “client”. It is important to realize that a client is not always one individual, and to recognize the impact of educating a parent for their own oral health, and for their children. We learned that raising oral health awareness and knowledge of one family member has the potential to improve the oral health of the entire family.

Positive Living

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As third year students, we prepared for our fourth year community practicum by shadowing the current fourth year class at various sites. Positive Living was one of these sites, and is unique in that it is a community centre in Vancouver for HIV+ individuals. In all honesty, I was initially a bit apprehensive when I learned about this rotation. Reflecting back, I know that my fears stemmed from a lack of knowledge on the condition and, albeit unintentional, a stigma I held toward HIV positive individuals. When I gained knowledge about the disease through scientific investigation and research, I felt more confident entering the facility and was able to appreciate Positive Living for the wonderful service they provide to a diverse and truly remarkable population.

HIV Education

Since then, I have found that one of the most interesting things I have learned in my dental hygiene education has been expanding my knowledge surrounding HIV. As a dental professional, having the knowledge and an understanding of HIV is important as there are many oral manifestations and in addition to overall health, the condition can greatly affect the oral health of the individual. In addition, a dental professional is in a position to raise awareness of HIV, and can also be one of the initial points of contact between an individual who has contracted HIV and a health care professional.

 

Debates

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The ability to debate a topic is essential as a health care provider. Although the debate may not be a formal one, a dental hygienist will find themselves debating importing issues with clients, other dental hygienists, and other health professionals. It is important that a dental hygienist can show his or her expertise, knowledge, and understanding of a topic using scientific research to find evidence based information to either support or refute an argument.

Last year, I participated in a debate held annually by the third year Dental Hygiene class. Although we felt we had limited knowledge on the topic, my group and I decided to take an anti-fluoridation stance in the debate. Initially, I had found it difficult to rally against water fluoridation – something that I had previously strongly (and perhaps somewhat blindly) advocated for.  In the process of preparing for the debate, I learned to use critical thinking and scientific investigation to prepare myself to intellectually discuss a highly controversial, yet essential element of dental hygiene practice – fluoride use. Preparing for the debate prepared me for the “real world” where I am not constantly surrounded by dental professionals, and I will likely meet more people who do not believe in fluoride. From participating in this debate, and especially choosing a stance that I did not previously take, I learned a lot about the science and reasoning behind choosing not to use fluoride, instead of only the reasons that advocate for its use. I feel that I can help guide my future clients in their decision making around fluoride, and can provide a less bias and more evidence based information.

My debating skills were further tested in fourth year, where I participated in an amalgam debate. The topic focused on whether dental professionals should use amalgam as a restorative material. As a hygienist, my experience with restorations has  mostly been detection of recurrent caries, looking for defective margins, and assessing the need for placement of restorations. Although I work with restorations in clinical practice, and I have completed biomaterial courses, I had previously not given much thought to what type of restoration should be used for my clients. In preparing for the debate, I realized that as a dental hygienist it is important to not only know the difference between the materials, but be able to give sound reasoning and advice to clients who may have difficulty deciding which they would choose. There is not only scientific reasons for choosing one material or another, but the social aspects of the decision are equally as important. Once again, I learned from this debate that it is important to know both sides of the argument in order to give unbiased and scientific evidence to clients.

 

Union Gospel Mission

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For the second semester of my fourth year, I had my second community rotation at The Orchard, a housing complex that is sustained by the Union Gospel Mission (UGM). Much like my rotation at Broadway Pentecostal Lodge, the goal of the rotation is to provide debridement services as well as health promotion and promoting self-care to individuals in this community. UBC provides three chairs and two dental units for the four UBC dental hygiene students to provide treatment. Clients are recruited by advertising to those who live in the housing complexes, as well as the UGM Welcome Centre.

Calculus removed from a man who has not seen a dental professional for 10+ years.

A stark difference between the two sites, however, is the population that we are serving. UGM provides services for low-income individuals and families, as well as immigrants and refugees. The people who access help from UGM vary greatly in terms of demographics, ethnic and cultural background, and also in terms if their oral health needs. Many of those who sought care at UGM had not seen a dental professional for many years, and some had never seen a dental professional before. It is evident that there is a great need for dental hygiene services within this population, as many people are eager and willing to seek treatment at this community site.

During this rotation, there were many clinical challenges due to the setting that our “clinic” took place, as well as a language barrier between the dental hygiene students and a majority of the clients. However, we were able to provide dental hygiene treatment to a number of individuals in need, and in turn, learned a lot about cultural competency as well as honed our clinical skills in order to provide efficient and effective dental hygiene care.

Broadway Pentecostal Lodge

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Broadway Pentecostal Lodge (BPL) was the community site that I visited in my first semester of my fourth year. The services we provided included intra- and extra-oral examinations, debridement, fluoride application, and denture care.

At Broadway Pentecostal Lodge, there was a steep learning curve for myself and my teammates, as we had limited experience providing dental hygiene services in a long term care facility. The population at BPL is quite specific, and as such, is very different from what we commonly see at the UBC clinic. We provide services to elders who commonly have a variety of illnesses and conditions and related medications, and many who have behavioural or physical disabilities.

In addition, the setting is unusual to us, as we provide care in the elder’s beds or wheelchairs with neck support – much different than the ergonomically-friendly chairs we are used to at UBC! However, despite these challenges, our site facilitator, Susan, was an incredible resource for us as she has a wealth of knowledge and experience working in long term care facilities.

I learned a lot from my rotation at BPL, not only about implementing care for elders, but also how to communicate with elders and other health professionals, increased my ability to use paper charts, learned the barriers and difficulties associated with running a practice in residential care, and also gained knowledge on the population and their specific needs.

Vancouver Native Health Society – Battered Women’s Shelter


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A few members of the 2014 dental hygiene class joined the DMD students for a volunteer project at the Vancouver Native Health Society early this year. We helped the DMD students distribute oral self-care kits and demonstrate oral self-care techniques to 40 Aboriginal women who had experienced abuse and who met together on a weekly basis. This experience was eye-opening as the women shared first hand experiences of mistreatment by dentists and expressed their lack of trust of dental professionals. Many of the women have not sought dental treatment since these negative experiences. However, despite this, the women were very interested in increasing their knowledge on oral health. Some of the women expressed that they did not want their children and grandchildren to experience the oral health issues they have faced. The women were patient and open to our advice and suggestions, and were grateful for the time we spent with them. It was a wonderful opportunity to apply the knowledge we have gained about oral health as well as the social factors involved with populations with unique needs – such as women, Aboriginals, and individuals who have been abused. We were able to provide toothbrushes, floss, and other oral self-care items along with the knowledge on how to properly use them in the hopes that increasing their oral health knowledge would foster confidence in themselves and in dental professionals. As important figures in their families and community, I hope these women will also be able to share this information with others and continue to increase oral health awareness in this population.

The Dental Mission Project – Anaham Reserve

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I was fortunate to be able to be a part of the Dental Mission Project team that visited the Anaham Reserve in the Summer of 2012. On this trip, dental and dental hygiene services were provided to the people living on the reserve and also neighbouring Aboriginal communities. The experience was a culture shock for me, as I have not been many places in Canada outside the lower mainland. The beautiful scenery, the rich and traditional culture of the Chilcotin people, and the copious amounts of bannock were incredible; but nothing could compare to the experience of providing dental service to this underserved population, and the overwhelming appreciation we received. From this experience I learned the importance of communication and collaboration that laid the foundation for a successful outreach project.

 

ADPIE Client

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During the first semester of my fourth year, the main clinical examination was the Process of Care or “ADPIE” assessment. The client chosen as the ADPIE had to meet a few criteria, including being P3/P4 perio status, requirement of images to supplement assessments, and requirement of local anesthesia in minimum of one area for debridement.

The client I had chosen was a P4 client who had not seen a dental professional for two years prior to seeking treatment at UBC.

She is a 72 year old woman who presented with controlled high cholesterol and hypothyroidism. At initial assessments, her periodontal pockets ranged from 5mm-8mm.

Radiographs revealed generalized horizontal bone loss and areas of vertical bone loss, and mobility in several areas, notably 18.

Treatment plans involved full mouth debridement using local anesthetic, stain removal, and fluoride application. Promoting self care was emphasized with this client as she was willing to make the necessary changes to improve her oral health, but did not have the knowledge to do so. Lessons emphasized cleaning specific “tough” areas in the mouth, such as the class II-III furcations on 18 and the 44-47 bridge, as well as generalized oral health instruction on flossing and brushing techniques.

Overall, this client proved to be a challenge for me. Although I felt competent in my clinical skills, there was much to be learned from this client. I was able to gain confidence and experience with providing local anesthesia for debridement for this client as it was required for the majority of the dentition, and it was especially challenging as she had irregular anatomy. Due to the recession, furcations, deep pocketing, and other issues present, I learned to use a variety of instruments that I previously did not feel confident in using. I was able to finish the appointments in less time than I had planned for because of these skills I had gained. In addition, I was able to build rapport and trust with this client, despite an existing language barrier and the client’s low oral health literacy.

I was very pleased to see many improvements in the client at the re-evaluation and recall assessments. There was a reduction in plaque accumulation, BOP, and pocketing. She had become confident in her oral hygiene practices and it was evident that she had made a conscious effort to improve her oral health. As much as I was glad for her oral health successes, I am even more so grateful for how she helped me as improve as a clinician.