Dental Hygienist in Private Practice

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In private dental practices, the RDH often spends more time with the client than the dentist, and sees roughly seven-eight clients per day. With recall intervals ranging from three months to one year, depending on health status, the RDH is often the most frequently visited HCP. The value dental hygienists add to a practice can be calculated through the cost of the chair and adding services provided, from maintaining professional standards, and client-centred care which keeps the client coming back.

The variety of factors that contribute to the revenue I produce and value I add in a private practice have increased my appreciation for my professional role. The CDHA’s Job Market and Employment Survey outlines reported highlights such as wage and working conditions,  challenges, and what to expect in the future.(1) Findings from the CDHA survey reveal RDHs face barriers, possibly due to the exclusion of an employment contract.

Employment contracts protect RDHs from loss of pay, but also serve as an opportunity to negotiate work-related benefits. As a newly graduated dental hygienist, an employment contract is important to advocate for my professional standards, gain professional development benefits, and have frequent feedback on my performance. Each of these benefits contribute to client safety, professional practice, and maintenance of DH competencies. For myself, my professional goals upon entering private practice are to manage learning, seek mentorship, and practice according to professional standards.

For myself, I think it is important for RDHs to know the value we add to dental practices and maintain current with life-long learning. Employment contracts are a tool RDHs can use as a profession to receive benefits that support our contribution to dental practices.

References:

  1. CDHA. 2017 job market and employment survey [Internet]. Ottawa, Ontario, Canada: Canadian Dental Hygienists Association. 2017 [Cited 2019 Apr 5]. Available from. https://www.cdha.ca/cdha/Career_folder/Job_Market___Employment_Survey/CDHA/Career/Survey/Job_Market_Survey.aspx?hkey=e3d1dbda-c64c-4b5a-9f0e-59ac6e0cd39f
  2. Kanji Z, Laronde D. Career outcomes of dental hygiene baccalaureate education: a study of graduates’ professional opportunities, further education, and job satisfaction. J Dent Educ. 2018 Aug;82(8):809-18.

Self-Reflection

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Throughout the DHDP, my view of the DH profession has expanded from a clinical role to a primary health care role. In the first year of the DHDP, I was assigned to write a self-reflection paper about why I chose the dental hygiene profession. In summary, the main points of pursuing an education in DH were to work collaboratively within a dental-team, remove deposits, and build rapport, derived from my past as a dental assistant. In the last four years I have grown beyond my previously held beliefs about the DH profession and developed the mindset of a health care professional.

At this point of my DH education, I have provided over 700 hours of clinical DH services and over 400 hours of community care, collaborated inter-professionally, and completed assignments that showcase the opportunities I have to advance the DH profession. Throughout three years of providing clinical care to the general public, children, and underserved populations. The experiences I have had providing client-centred care has given me the opportunity to explore practice standards, policies, code of ethics, and use scientific investigation to provide the gold standard of care.

As I progressed through each year of academia, I had moments of transformative learning which allowed myself to grow professionally. Awareness of scope of practice and core skills gave myself the opportunity to know my professional limitations, but also an advantage in inter-professional settings. Upon participation in a variety of inter-professional events hosted through UBC, I advocated for my profession by sharing my role and responsibilities among other HCP. Inter-professional learning increases access to care with a range of health professionals and facilitates increased health outcomes.(1,2)

Looking back to my self-reflection essay, I recognize moments of growth and transformative learning which attribute to the value I have of dental hygiene today. Having a vast array of clientele, I learned how to provide client-centered and community care within the parameters of my licensing body and how to support clientele when their needs were beyond the scope of a dental practice.

Kanji Z, Laronde D. Career outcomes of dental hygiene baccalaureate education: a study of graduates’ professional opportunities, further education, and job satisfaction. J Dent Educ. 2018 Aug;82(8):809-18.

References

  1. Wakabayashi H. Medical-dental collaboration in general and family medicine. J Gen Fam Med. 2019 Mar;20(2):47.
  2. Kanji Z, Laronde D. Career outcomes of dental hygiene baccalaureate education: a study of graduates’ professional opportunities, further education, and job satisfaction. J Dent Educ. 2018 Aug;82(8):809-18.
  3. Canadian competencies for baccalaureate dental hygiene programs. Ottawa, ON, Canada: Canadian Dental Hygienists Association; 2015. 41p.

Cause Advocacy

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Harm reduction aims to reduce stigma and keep people who use drugs (PWUD) safe through reducing injury, disease, and death associated with high risk behaviours.(1) In my fourth year of the UBC DHDP, myself and three other DH students developed an advocacy project to increase access to care for PWUD in dental clinics.

Our project targeted both dental HCP and PWUD. Our mission is to educate HCP dental professionals about the social determinants of health, poor oral health affects on quality of life, stigma and discrimination this group faces in health care settings, and how to provide cultural competence and safe care for this population.(2,3) On the other hand, the projects mission for PWUD is to provide personal self care (PSC) tools, and develop a relatable logo that is recognizable for them to access dental care.

Cause-Advocacy Project Logo featuring the plant forms of which drugs are derived; marijuana leaf, poppy, nicotine flower (left to right).

Our team has gained support from stakeholders to continue moving forward to advocate for this population within the dental field, and eventually expand into all health care practices.

Presently, the logo was designed by the team, but will undergo further design by a PWUD focus-group to reflect harm reduction. Additionally, a grant and sponsorship proposals are the next step to launch an educational piece to gain local dental HCP supporters in the community and distribute our brand, gain funding for an oral health event in the PWUD community, and provide PSC tools with logo.

References

  1. British Columbia Ministry of Health. Harm reduction: a British Columbia community guide. Victoria, BC, Canada: British Columbia Ministry of Health; 2006. 27p.
  2. Brondani MA, Alan R, Donnelly L. Stigma of addiction and mental illness in healthcare: the case of patients’ experiences in dental settings. PLoS one. 2017 May 22;12(5):1-13.
  3. Lopresti S, Ngo D, Tocchio J. Methamphetamine use and oral health: management and treatment considerations. Can J Dent Hyg. 2013;47(4):176-81.
  4. Canadian competencies for baccalaureate dental hygiene programs. Ottawa, ON, Canada: Canadian Dental Hygienists Association; 2015. 41p.

Immigrant Services Society

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The Immigrant Services Society of British Columbia (ISSBC) is a program for immigrants to gain life skills upon their arrival to Canada. In my second year of the DHDP, Myself and three of my classmates formed a team to provide oral hygiene education for Asian immigrants learning English.

Our team approached this community site by learning about cultural competency and common oral hygiene instruments, such as tooth picks, used by the population  foreign to western culture.(1) Our team was challenged with a language barrier, but developed presentations using basic language, pictures, and evaluations in small groups to help enforce the lessons.(2) Although most of the time we were able to communicate with the ISSBC community immigrants, sometimes they could not understand what we were trying to describe. As a team we would critically think on the spot to effectively communicate with them. For example, during our presentation teaching them about which floss is appropriate for them, the community had difficulty understanding waxed floss. Together, we tried to describe wax, but we then had the idea to use yarn and tear it apart to describe why we recommend using waxed floss.

This experience me was my first oral disease prevention activity in a community setting and I learned about communicating with language barriers and explaining oral conditions such as gingivitis, cavities, etc. in a simplified way. Most importantly, having the opportunity to learn from a community from a different cultural background from myself challenged the way I think about western practices, and how I can help clients navigate their oral health according to what is right for themselves.

References

  1. Lin HC, Schwarz E. Oral health and dental care in modern-day China. Community Dent Oral Epidemiol. 2018;29(5):319-28.
  2. Lynch T, Maclean, J. Exploring the benefits of task repetition and recycling for classroom language learning. Lang Teach Res. 2000;4(3):227-35.

Client-Centered Care

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As primary HCPs it is our role to see the client as a whole rather than solely on their oral health needs and findings.(1,2) In my fourth year of dental hygiene, I have now provided dental hygiene care over the past three years and I have grown as a primary health care provider and clinician.

I believe what helped me realize the importance of CCC, was the dental hygiene process of care model and the continuation of care from developing SMART goals.(1) The assessment portion of the DH appointment reveals past and present health conditions and societal factors that impact oral health. Collecting assessment information is crucial to developing a diagnostic statement and guides the planning and implementation of the care plan. A transition in my learning occurred when I realized a pattern of unmet SMART goals under my care. After identifying failure to develop client-centred SMART goals based on assessment findings, I began communicating with client. Individualized oral health care education and disease prevention competencies became a routine part of the creation and delivery of SMART goals to motivate my clients. For example, in my third year of dental hygiene I had a new client to the UBC DHDP who presented with periodontitis and hypertension. I advocated for my profession and for him through identifying the bi-directional relationship between his cardiovascular health and periodontal disease. The client was interested in learning more about the relationship between these diseases and how he and I can work together to prevent exacerbating either condition. At his re-evaluation appointment, the client achieved his SMART goal and I noticed an improvement in his oral health and value under my care.

References

  1. CDHA, Lavigne SE. Your mouth — portal to your body.Probe. 2004;38(3):114-34.
  2. Morris JE, Kanji Z. Exploring how the quality of the client-dental hygienist relationship affects client compliance. Can J Dent Hyg. 2016;50(1):15-22.

Developmental Disability Association

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The Developmental Disability Association: Leisure Challenge Program (DDA-LCP) is an after-school drop-in program designed for teenagers with developmental disabilities (TDD) to develop social and life-skills.(1) Myself and my two other DHDP team-members designed two lesson plans for the TDD on Oral Self-Care and Nutrition, based on observations of the site, community assessment, and facilitator recommendations. Further, my team and I asked the TDD questions about what they knew about their oral health and what they are interested in learning about. From this information, our team structured lesson-plans to include an interactive mini-lesson, hands-on activities, SMART objectives, and an evaluation game. We designed our lesson plans to build on the foundation of knowledge on these topics and engage with the group of five TDD. The highlights from my experience at the DDA-LCP were developing rapport with the TDD and learning about the TDD from the facilitators and their guidance with our program development. Prior to my community engagement with the TDD at the DDA-LCP I had little experience with this population. Going into the DDA-LCP site I did not know how to communicate with the TDD and our team were faced with challenges regarding how to avoid making our lessons childish. As we spent more time with the TDD and facilitators we learnt that there is not a way of how to communicate with individuals with developmental disabilities. Instead, I realized that, as a health care provider, I communicate with the TDD population like I do any individual. Through our education at UBC, we learnt that people with developmental disabilities face barriers when accessing health care and are more vulnerable to caries, periodontitis, and other systemic health issues. (2,3) Moments of unlearning, are critical to providing care for people as sometimes our expectations limit the opportunities that we can gain from working and learning about how we can work together to promote health.

References:

  1. Children and Youth [Internet]. Developmental Disabilities Association. [Updated 2018; cited 30 November 2018]. Available from: https://www.develop.bc.ca/programs/children-and-youth/
  2. Whiteley AD, Kurtz DL, Cash PA. Stigma and developmental disabilities in nursing practice and education. Issues Meant Health Nurs. 2016 Jan;37(1):26-33.
  3. Ziegler J, Spivak E. Nutritional and dental issues in patients with intellectual and developmental disabilities. J Am Dent Assoc. 2018 Apr;149(4):317-21.

John Howard Society

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In the first term of fourth year I went to the John Howard Society (JHS) on Wednesdays over three months. I had visited JHS once before and liked the community. Traditionally JHS is a program for men with incarceration history, but the lower mainland (JHSLM) office accepts men, women, individuals with developmental disabilities, and struggle with substance abuse. At this community site I had the opportunity to work alongside JHS outreach workers, volunteers (a prospective dietetics student and a resident artist), and implement a dental hygiene services program within the JHSLM site. Many of the clientele did not have dental to insurance unless they were first nations or had a disability, and most of these programs offer a maximum every two years.(1) As a personal goal I helped redesign a sheet of reduced cost dental clinics with the details of acceptance based on common insurance plans and address to help determine where to refer for general dental care. Many of the clients myself and my team-mates seen were referred to reduced cost dental clinics which usually reduces the standard fee guide by 10%. Although I advocated for the JHS clients by making referrals, I wonder how realistic accessing these dental clinics are for these individuals as many of them will need to pay for new patient or specific exams before receiving care. I would further like to become involved in the referral process and learn more about insurance plans so I am better able to refer and help my clients better understand their insurance plans. In addition, my team connected with the resident artist and the prospective dietetics students to organize a nutrition activity with the JHSLM clients, where we brought healthy snacks, coloured, and played a food-groups game with them to help them build their confidence choosing healthy snacks and learn about the food groups. Throughout our experience at JHS we had many opportunities with showcased the lack of nutritional education. Our team had gone to Kent maximum security prison and visited a half-way house. During both of these opportunities we noticed that the community did not have much access to learning or developing skills about nutrition and preparing meals. Rather we learned that most of the food this community is exposed to in prisons and half-way houses are non-perishable because it is cost-effective. In conclusion, advocacy played a large role in this community setting because of the limitations of accessing dental care, as well as limited nutritional education. Having this experience was insightful because I was able to grow as a health care professional, but it also inspired me to learn more about advocating for communities.

Reference

  1. Disability coverage [Internet]. BC, Canada: Pacific Blue Cross. [Updated 2018; cited 2018 Nov 30]. Available from: https://www.pac.bluecross.ca/group/large-business/common-benefits/disability-coverage/
  2. Porter LC. Incarceration and post-release health behaviour. J Health Soc Behav. 2014 Jun;55(2):234-49.

Patchwork

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Patch Summary: Analysis of opportunities for inter-professional collaborations

A recurrent theme of opportunities for inter-professional collaborations is present throughout second year. I feel like this topic has been interlaced throughout the program, evident in clinic, class, and UBC’s inter-professional events (IPE). Through this experience I realized learning from inter-professional collaborations makes me a stronger clinician and health care team member.

In our classroom, we have with lengths of subjects to cover led by experts in the field. When I was studying to become a dental assistant, we had classes with the same description as dental hygiene courses. So in my naivety, I thought the content would be similar. However, I now see my past education as an introduction, because I am getting a more in-depth, science-based education. However, the establishment of relationships with faculty from other professions has helped me grow. For example, in 206 we had three instructors who specialized in different areas to teach a single class. Initially, I struggled with some of the deeper concepts of anatomy. After I established a relationship with each of my professors, I learned more about them and how I can apply what I learned to my clinical skills to better understand my client’s needs regarding each of the topics they specialized in. The dialogue created between these professors and I opened the door to have a better understanding of the class and client care.

In our clinical sessions we work with dental assistants, dentists, technical support, and our clinical instructors, to name a few. As students, it is important to work alongside professionals who hold these job titles to care for our clients and prepare us for the future. Working with dental professionals allows for learning “through observing others, listening and asking questions directly related to patient care, and participating in discussion.”(1) For example, technical support is a phone call away to make sure my operatory is working, when I have a question regarding my clients oral health I can ask my clinical instructor or the dentist, and the dental assistants help me in various ways when seeking dental supplies. Having the experience to work with UBC’s dental team while providing client care provides us with support, while also learning how to work independently.

Within our curriculum, we are encouraged to participate in IPE. I remember being nervous about entering a class with other health care students. However, after our group was handed scenarios, I felt like my opinion was valuable, and sometimes my peers thought of things I never thought of, or I was able extend on thoughts expressed by other health care students related to dental hygiene. Since, my experience with IPE has been positive and has helped me to value “developing and rehearsing the appropriate skills in a safe environment” with my peers that will soon be part of my broad health care team.(2) My experience with IPE has changed the way I view collaboration, and I think is an effective way of providing care to our clients.
References

1 . Nisbet G, Dunn S, Lincoln M. Interprofessional Team Meetings: Opportunities For Informal Interprofessional Learning. JIC. 2015 May 15;29(5):426-32.

2. Hardisty J, Scott L, Chandler S, Pearson P, Powell S. Interprofessional Learning For Medication Safety. TCT. 2014 Jul;11(4):290-6.

Gadbury-Amyot C, Asadoorian J, Biggar H, Chisholm R, Compton S, Craig B, Darby M, Gordon S, Grant P, Mackie S, Matheson S, Neish NR, Sunell S. Canadian Competencies For Baccalaureate Dental Hygiene Programs. CDHA. 2015:1-41.